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Bipolar disorder & ADHD - need advice....

Been waiting for OT day to open….

It’s sort of weird to be posting about this topic on a horse forum, but… well, the short answer is I have a lot of respect for the people of COTH. I want to talk to someone about their experiences with living with bipolar disorder and ADHD. I apologize that this will be a bit of a novel.

I’ve been blessed with a very close family so my brother’s kids are very, very close and dear to me. My nephew is 26. As a kid, he was very sweet, bright and loving. In high school he started to “goof off” – skipping classes, not handing in assignments etc. He didn’t appear to be involved in drugs or any criminal activity; just seemed to be a lazy and unmotivated kid – the kind who would get 90’s if he was interested in an assignment, and skip tests because he “slept in”. We thought he would mature and grow out of it. He went off to university and had a complete crash-and-burn – he may have finished the year with one credit, if that. Things got worse. He would move out for a few months and get a minimum wage job, but would promptly lose it, run out of money and come back home. His behaviour got more erratic – he started telling bizarre lies; his personality changed from being sweet and thoughtful to loud and arrogant; he’d buy a $600 coat and tell his parents he needed rent money because he’d been mugged. Eventually he was diagnosed as having bipolar disorder and ADHD. Lots of ups and down (with weird physical and mental symptoms) until they were able to sort out medication that kept him relatively stable.

He has spent the last 3 years living in his parent’s basement doing literally nothing. Most days he would venture outside to smoke on the porch and nothing more. He has tried a couple of programs at community colleges and has failed or dropped out. He has lost every minimum wage job he has had because he is chronically late or misses work. His parents finally pushed him out of the house a few months ago, but it won’t last – he’s already on his last warning from his call center job regarding absenteeism.

He hates himself. His puts on a front that can be exasperating – you ask him how he is and he says “great!” – but he also talks about suicide. He has no successes – even small ones – to feel proud of. He can’t even organize getting showered on time.

He does take nice photographs and he mentioned to me that he wants to take a program in photography at the community college. I am normally a really optimistic person and it takes a lot for me to be so gloomy, but I am 100% certain that in the state he is in he will not complete this program. His parents are not doing well financially and are not in a position to pay for it. I would pay for it (with parents’ permission, of course) but I am scared it’s a bad idea. Losing the money is the least of it -- I am so worried that if he fails again it will only push the spiral down faster.

I love this kid -- fiercely. I love him sick or well. My heart breaks for him -- I want him to be happy, I want him to like himself but I don't see the path that will lead him out of this wilderness.

I have some recent experience with this specific issue (and we're coming out the other side!), but I will PM you as I don't want to discuss personal issues that are not technically "mine" on an open forum.

As far as ADHD goes, the most valuable thing you can do is to continually be a positive support. Years ago there was plenty of whining and b*tching in my family, and it only created a lot of hard feelings, and difficult lives. What a difference to hear what you can do, vs what you can't. Why not maintaining all As is not the end of the world.

Not being Suzy Sunshine, but just be supportive, and quiet when things are failing. They are hard enough on themselves. But also don't enable the misuse or lies/covering up. And never doubt what they might be able to do, especially when inspired, because they may very well some day.

If there is any way your nephew can find a mentor in photography. Any job in a shop, with a photographer. Maybe an extension course. Or just to get out to whatever venue he prefers and keep snapping. If he can put something together that displays his talents. A web site, portfolio. Something tangible he can look at to see what he can produce...

Hope he gets there!

How can there be so many currents in such a little puddle? National Velvet

Thanks CVPeg. I hear what you are saying, truly I do -- I am really trying to be supportive and positive. It's just that things can be so inexplicable. For example, he posted a few photos on his facebook and I commented that I loved one in particular, and asked him to quote me a price because I wanted to buy it. He didn't respond (or rather, he did but didn't mention me buying) so I said, "really, I want to buy it -- what's your price?" I eventually offered what I thought was reasonable and he said yeah, he'd get it printed... or send me a digital copy... I sent him the money because I thought maybe he needs cash up front to get it printed. That was 6 months ago...

Just wanted to let you know that the Equestrians with Disabilities Forum includes mental as well as physical issues we may face, so you don't have to wait for an OT day if you have any additional questions.

Just wanted to let you know that the Equestrians with Disabilities Forum includes mental as well as physical issues we may face, so you don't have to wait for an OT day if you have any additional questions.

Thanks -- it actually didn't occur to me because he's not a rider! . I appreciate the suggestion

Instead of spending money on college, what about some sort of inpatient therapy? Is he open to counseling? I think the money is probably better spent on treating his illness at this point, but in order for it to work he needs to be invested and to take his meds, which is why I think inpatient would be best, at least at first. Mental illnesses are awful; I feel for you, him, and the rest of your family. Good luck.

He has spent the last 3 years living in his parent’s basement doing literally nothing. Most days he would venture outside to smoke on the porch and nothing more. He has tried a couple of programs at community colleges and has failed or dropped out. He has lost every minimum wage job he has had because he is chronically late or misses work. His parents finally pushed him out of the house a few months ago, but it won’t last – he’s already on his last warning from his call center job regarding absenteeism.

…

This is NOT successful treatment of either BP or ADHD. It sounds the behavior of someone who could be depressed, or smoking a ton of weed (also consisent with his behavior), or drinking, or doing some other drug ,or be experiencing some psychosis, who knows? Or it could be a personality disorder.

The best thing would be getting a real evaluation, with testing, and lots of collateral sources of information. I don't consider myself a cynic but sadly, the drug angle is really common, not that I think that is the explanation but it is ONE possibility.

typically, ADHD behaviors are observable prior to age seven, not that they are not now looking at various adult manifestations but true ADHD does not generally "start" in high school. If he did not have particular problems prior to that, i would not be very impressed with an ADHD presentation.

I'm so sorry for you. It can be such a dreadful illness; one of my close friends has bipolar disorder and she too is incredibly intelligent and interested in so many things, and also had a complete burnout in college (except including a psych admission, so she was properly diagnosed).

We're in our 30's not and she works minimum wage jobs and relies on her (also not doing that well) parents for financial support. I really worry about what'll happen to her when her parents can no longer help with rent money. Her own money she spends on whatever hobby is currently obsessing her, and she delves into them completely. For ex, when she decided to learn how to make sushi she also needed top-line sushi knives from chef shops to make her pseudo-Cali rolls, that kind of ridiculous thing. She has all these dreams, but is unable to follow through on anything. She does have periods where she's together, can attend classes and does well, but after several months she gets off the rails. Often because she stops her meds because she's "better".

I know this isn't helpful, or hopeful. I have heard of people, friends of friends, who are stable on medication and doing well, but she's the only person with bipolar disorder I'm close to and she is obviously not doing well despite ongoing psych care (meds and counseling).

Thanks, everyone -- your replies are much appreciated . I still haven't figured out the multi-quote function, so I'll just have to paraphrase

RedMare01 -- I would love to see him get some inpatient therapy .

liltiger2 -- just to clarify, he is smoking cigarettes on the porch, not weed -- though I see what you are saying. Although I am sure he's dabbled pretty heavily in stuff when he's been out on his own, during the time he was at his parents he was basically cut off from the outside world -- literally. They live in a rural area; he doesn't drive or have any friends in the area so access to illegal drugs would have been limited. However, he does drink -- even though he knows he shouldn't. I know he has been assessed by a psychiatrist, but sometimes I wonder if his diagnosis is accurate, too.

Interesting what you note about the ADHD diagnosis in childhood. He wasn't diagnosed, but they moved around a lot and I think that makes it harder to get a handle on what's going on. He was definitely not what I (as a non-professional) would think of as an ADHD child, but he was definitely quirky in two notable ways:

1) He was extremely fearful. He never learned to ride a bike or swim or skate; he would never scramble on playground equipment or climb trees. Amusement park rides terrified him. At the time I just thought he was a bit of an "egghead" -- a kind who lived in his mind and was just not cut out for physical play.

2) He was really obsessive -- when he was into dinosaurs, he talked about them 24/7 (as a biologist, that was fun for me!). When he got his first Nintendo (he was about 8 or 9), his parents had to unhook it every night or he would sneak downstairs and play SuperMario all night long.

Coanteen -- OMG, that's him to a T -- even down to the knives. One of the things he was in to was cooking -- he started and dropped a program in culinary arts, but he "needed" a set of knives worth hundreds and hundreds of dollars.

typically, ADHD behaviors are observable prior to age seven, not that they are not now looking at various adult manifestations but true ADHD does not generally "start" in high school. If he did not have particular problems prior to that, i would not be very impressed with an ADHD presentation.

That's what I was thinking. Any chance he is using drugs? Even prescription pain pills? Sounds more like he figured out that it's more fun to not work and hang around and smoke. And people that use drugs are very manipulative. One in my family does the "I'm so ugly, bad, etc, no one likes me, I don't know why I bother living, no one would miss me if I was gone" to manipulate my mom into giving her money, and not enforcing rules.

Thanks for your reply, jetsmom -- I addressed a bit of this in my last post. Of course it is possible he's doing drugs, but during the 3 years he was back with his folks it would have been hard to even get access to drugs -- he really lived like a hermit in a cave. He does, however, drink quite a lot which definitely contributes to his problems....

I think the most important thing, from the sounds of it, is getting him successfully treated....whatever medication he's taking (IF he's taking it, which can be a huge problem in mental illness treatment) is clearly not working. Is there any way to get him help? It sounds like a thorough re-evaluation is needed.

Just because it's rural, you can still get "stuff". I lived in Tuftonborro NH for a while when I was a teen, and it is TINY. One small general store serves as the post office/gas station/store. One motel. Friday nights were pizza at the motel bar and grill. Yet we still found pot, and other drugs. Easy to grow pot. Especially if there is land that is vacant/wild.
Whipped creme, paint, glue, computer dust sprays all can be inhalants. Bath salts are easy to find in many places or by mail. Any high schooler can usually tell you where to get pills.
My brother lived/lives in a small town and was addicted to Oxycontin. I think he is still doing something, but not sure what.

Not trying to say he can't be ADHD, but as mentioned it's usually diagnosed young.

I know, people can get pretty creative about getting stuff in small towns. But when I say he didn't leave the house I mean it -- there were weeks when he didn't put on shoes. It's not impossible that he's using something -- you've raised some possibilities I haven't even thought of -- but I don't that's his main problem.

b_r_o: I know . The thing is, they have played around a lot with his medication and this, believe it or not, is better than it was. Somehow I thought they'd tinker with his meds and he would eventually get well. But it's been years and while he's not catatonic, he's far from well. It's just so discouraging....

That's very sad Would he be open to therapy? A psychologist? Maybe just having someone to talk to who would has been trained to help someone with his struggles. Unfortunately, sometimes meds can only conquer half the battle, and the person needs to find it within themselves to bring the rest of the pieces together....fingers crossed that he finds that motivation.

Haven't got any huge success stories here, one is bad, had a med change and was much improved and then died, and the others are struggling. Really agree with bro, the two struggling ones - one is taking ADHD meds (diagnosed late in life) and has a very supportive relationship so is doing OK although makes some what I would consider bad decisions and the other takes no meds that I am aware of but has found a job driving over the road which works for him, while it lasts - he's another grass is greener type.

I don't know how to describe it but there is a difference between the drug users and the mentally ill, at least the ones I know, although one of them did get heavily into crystal meth. Chain smoking and being really walled off from people.
OP, I wouldn't fund a class because they go into it like whirling dervishes and then lose interest. If you fund anything make it easy to go to treatment - but don't tell them that you are funding it. One of my examples took felony jail time over paying for counseling. The judge gave him the option and he took FELONY jail time because he "couldn't afford it". Didn't ask any of us to help pay for it. Asks for investment in his "hobbies" as called in another post.
Sorry I can't be more optimistic.

Well, still from what you wrote I would not be thinking ADHD at all, or bipolar disorder (is there a family history of this, just wondering what got the professional thinking of it). And alcohol itself is a depressant! and it certainly contributes to many people losing jobs, relationships and so forth, sadly (and jetsmom is very right that folks in small towns can get ahold of whatever they want). And alcohol mixed with medications has plenty of added complications.

I still vote for a psych eval, done by a psychologist.Not cheap but cheaper than a semester at school, or jail bond or an attorney! There are just too many things it "could be" its like throwing darts (could be this? could be this?) At the end of the day though, when we hear hoof beats its usually horses and not zebras (possible but much less likely!) so far, sounds like some kind of possible mental health issue NOT helped by alcohol use (which then becomes its own issue)

Insurance cos expect a diagnosis after the first meeting if we want to get paid but that doesn't mean that a full assessment was done!

It really sounds like he needs some inpatient therapy/diagnosis. He does not sound like a patient that has been properly diagnosed and treated. While I realize that sometimes it is difficult to get the meds to work properly, there are new meds coming out all the time. He should be in therapy with a counselor, and his meds should be being monitored by a psychiatrist- not a general MD or a counselor. Psychiatrists have specific training and experience with how different drugs interact and would definitely be able to help him find a combination that works. Of course, it a long process- most meds take about 8 weeks to really see what it is doing. AND people often have to change their meds over time. Brain chemistry changes, so what worked when someone was 30 isn't necessarily going to work when someone is 55.